Epilepsy Patients Who Do Not Respond To Drugs Should Be Referred To Surgery Sooner

Editor's Choice
Academic Journal
Main Category: Epilepsy
Also Included In: Neurology / Neuroscience
Article Date: 14 Oct 2011 - 0:00 PDT


Patients with epilepsy who do not respond properly to medication should be considered for surgery more promptly, researchers from University College London's Institute of Neurology reported in The Lancet. The authors wrote that nearly half (47%) of all epilepsy patients who underwent surgery were seizure free ten years later.

The authors explained that surgery for refractory focal epilepsy is becoming more common. However, there have been few thorough reports on the long-term outcome of such procedures.

Prof John S Duncan, FRCP, and team set out to determine what long-term effect surgery might have on patients with epilepsy - they focused on patterns of seizure remission and relapse after surgery. They monitored 615 adult patients yearly for eight years. The patients underwent the following surgical procedures:

• Anterior temporal resection - 497
• Temporal lesionectomy - 40
• Extratemporal lesionectomy - 40
• Extratemporal resection - 20
• Hemispherectomy - 11
• Palliative procedures - 7

Kaplan-Meier survival analysis was used to estimate when the first seizure occurred.

They found that 52% of them were still seizure free after five years (apart of simple partial seizures). After ten years 47% were still seizure free.

Those who underwent extratemporal resections had a greater chance of seizure recurrence compared to patients who had anterior temporal resections.

The longer a patient remained seizure free the lower his chances were of a subsequent relapse, the researchers found. In 18 of 93 patients, a late seizure recurrence was linked to the usage of an untried antiepileptic medication.

At the latest follow-up, 28% of the seizure-free participants were not on medications.

A patient who had a simple partial seizure (SPS) within two years of temporal lobe surgery was 2.5 times as likely to experience further seizures compared to those with no SPS.

Experts say patients should consider surgery sooner rather than later. Prof. Duncan said patients should also be realistic about the risks.

The authors say that the surgical methods and selection process for surgery need improving so that success rates are boosted. More care also needs to be taken to identify those who are not suitable for surgery.

The authors concluded:

"Neurosurgical treatment is appealing for selected people with refractory focal epilepsy. Our data provide realistic expectations and indicate the scope for further improvements in presurgical assessment and surgical treatment of people with chronic epilepsy."

Written by Christian Nordqvist
Copyright: Medical News Today
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